79 Ways to Fail in Dentistry – Chapter 1: Associates, Anaesthesia and Advertising

79 Ways to Fail in Dentistry – Chapter 1: Associates, Anaesthesia and Advertising

In my experience as not only an experienced dental professional but also a business coach, I see a wide range of challenges and considerations that present themselves in each and every practice. So by exploring them further perhaps we can uncover together the A to Z of not getting it wrong.

So, let's start with looking at the top three queries which start with 'A' in my A to Z of getting it wrong in Dental Practice.

1.  Associates

As good a place as any to start. Dental practice is an industry dependent upon associate dentists. Their employment status is privileged and they are, for the most part, currently classed as self-employed unless otherwise stated. Self-employment can be a double-edged sword and should be a winner for both sides but often goes wrong, here are some reasons why:

Four dental associates smiling


The agreement between the two parties should be clear and unambiguous. Unfortunately contracts are often out of date, no more than a handshake or ignored. They should be reviewed routinely to reflect changes in business practices, performance and evolving conditions.


Whether the business owner is one person or a multi-practice chain or corporate, a lack of regular conversations will lead to misunderstandings, a breakdown of communication and eventually conflict. These should usually be informal and peer-to-peer, but formal annual progress conversations are also advisable.

Cash (or Comprehension of Finances)

Most associates do not understand the financial elements of running a dental business. As part of the deal the business owners should ensure that the money part is clear. I consider it a responsibility of the principal to educate their associates in the nitty-gritty of their business. In the same way the associate should want to know where the money comes from and also where it goes.

Close up of male checking figures with calculator

Clarity of Status

Many associates enjoy the benefits that self-employment brings but are happy to ignore many of the responsibilities. In addition to looking after their own financial affairs, including the legality of their employment status, insurances and personal development; they also must show willingness to provide care for their patients when they are not in the practice. Turning up 5 minutes before scheduled start and exiting 5 minutes after the end is not demonstrating self-employed status. Out of sight is not out of mind.


It is both a two-edged sword and two way street. Presuming that the other side is happy unless they say so never works; both must accept that there will be differences of opinions. Having a dynamic relationship where both parties work to see the other’s point of view and also show willingness to compromise should lead to a successful, long-term working relationship. Unrealistic expectations lead to confrontation and disagreements.

So hang onto the 5 C’s:

  1. Contract
  2. Conversation
  3. Clarity
  4. Cash
  5. Consideration

Female colleague speaking with male colleague sitting at table.

2. Anaesthesia

One of the best things I ever learned was that not everyone goes numb in the same place, in the same way using the same technique. One of the worst things was my brother was the patient and he still reminds me of the fact. There are volumes written about pain, its causes and control, and I am neither qualified nor competent to cover them. What I do know is that one of the best ways to fail in dentistry is to presume that your anaesthetic technique is fool proof.

This is not an article about what solution or which technique nor is it about how to and where to use or even when. I will not mention polypharmacy, adjuncts or top ups. It is about the Why and the Who.

Female patient inhaling anaesthesia in dental chair


One of my Oral Surgery consultant bosses, the late James Schofield, said to me, “If you’re going to the bother giving someone an injection Alun, you really ought to be able to make sure it works”. It is an area of clinical practice where there is no place for arrogance or presumption, as pride will come before a fall.

I may seem obvious but unless you have been on the receiving end of a failed local anaesthetic no amount of empathy training will make you understand how vulnerable you will always feel. I have been and I still remember, where I was, who hurt me and when.


Patients should be able to expect that their individual needs are sought and addressed. Take a history of previous experiences of anaesthesia and analgesia. Tell them how you work, how gentle you are and what they can expect. Then follow through. No shocks, no surprises. From topical to intra-ligamental, Akinosi to infiltration and hypnotic suggestion to sedation your armamentarium needs to be comprehensive, your knowledge complete and your techniques dependable.

Male dental patient in pain reclined in dental chair.

This takes time, time to listen, time to inform, time to be gentle and deliver. There is no room any longer for the “banging in a local and sit them outside” that my first principals encouraged me to do.

Every anaesthetic is a separate entity, an individual technique deserving of respect and should demonstrate to your patient your philosophy of care. It is one of the things that differentiates you. Neglect at your peril.

Painless, practice produces profits.

Fail to freeze and you fail to please.

Happy smiling female dental patient reclined in dental chair

Advertising and It's Role - or Not

I will take this definition of advertising, “a marketing communication that employs an openly sponsored, non-personal message, to promote or sell a product, service or idea.” There is nothing new about advertising; the ancient Greeks & Romans used papyrus to make sales messages and wall posters. In the 18th century advertisements started to appear in weekly newspapers in England.

According to dentalmarketing.net, the first mention of text relating to dentistry was by the ancient Sumerians in 5000 BC. In 2600 BC, Egyptian Hesy-Re was a dentist described as, “The greatest of those who deal with teeth”, by an inscription on his tomb.

We’re all familiar with the claims made by hucksters and showmen of the 19th century when both dentistry and advertising were unregulated. The ties of promotion were eased again in the UK in the late 1980s, just as I opened my first practice. I soon made the same mistake that many others have by confusing advertising and marketing. I rapidly learned to about that three letter acronym, “ROI” which stands for Return on Investment.

Mature male professional planning and making notes

Let me share some examples of several investments I made, all of which cost near enough the same but had significantly different returns.

  • Small boxed advert, evening paper once a week for two months. Return zero.
  • Wooden “A-Board” sideways on to traffic on busy spine road. Return infinite, in fact almost overwhelming.


Close up of professional exchanging business card with client.

These were, of course, pre-internet days but the principles remain the same. There are times to cast your net wide and other times when it is best to focus. The lessons I learned can be summed up:

  • Appreciate the difference between marketing and advertising (clue: advertising is just one part of the marketing mix).
  • Always have some way of measuring the return on your investments.
  • Because it works for some businesses doesn’t mean that it will work for yours.
  • The best way to get people to refer their friends, family and workmates is to ask them; to give them an easy way to do it and to say thank you when they have done it.
  • Focus on what works, test what might work and abandon what does not work. It’s OK to make mistakes but not to repeat them.


Alun Rees - The Dental Business Coach


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